Why more large UK corporates are switching from PMI to healthcare trusts – Healix Health

September 26, 2025

Written by Ian Talbot, CEO at Healix Health

A rising number of large corporate healthcare subscriptions, that’s companies with more than 250 employees, are now run through healthcare trusts instead of traditional PMI, according to a recent LaingBuisson report. It’s a trend that’s been growing since the 1990s and now represents almost £1bn of the company-paid healthcare market.

That growth comes against a backdrop of rising healthcare costs, continued pressures on the NHS, and recent political debate about calls for VAT on private healthcare, leading many employers to reassess how they deliver health benefits.

Employer-backed private healthcare is highly valued. 55% of people say they’d be more likely to apply for a job if it were offered. Yet with costs rising and pressure mounting on employers, the question is no longer whether to provide healthcare benefits, but how. For a growing number of organisations, the answer is healthcare trusts.

Why the move to healthcare trusts

It’s no surprise then that many large corporates, including many FTSE 100 companies, are choosing healthcare trusts instead of traditional PMI because they offer better cost, control and clarity.

Unlike traditional PMI, trusts aren’t subject to the 12% Insurance Premium Tax that comes with PMI, and typically deliver around 10% savings over corporate PMI premiums. For large employers, that’s a saving that could run into the millions. And rather than paying premiums that disappear into insurer profits, those savings often go back into extra wellbeing programmes or broader healthcare benefits.

Predictability is another advantage. With PMI, companies face premium hikes annually, which often feel disconnected from their actual claims. In a trust, employers fund the actual cost of care. This transparency helps finance and HR leaders plan with confidence rather than facing unpredictable renewal hikes each year.

Then there’s the question of control. Trusts provide flexibility. They allow employers to shape benefits around the needs of their workforce. For complex, multi-site businesses, that flexibility is invaluable. In short, trusts empower companies to regain control over the healthcare they offer their employees, instead of a one-size-fits-all policy.

Outperforming traditional PMI

Healthcare trusts do more than simply save money; they deliver better outcomes. Instead of channelling premiums into insurer profits, trusts give employers the freedom to design benefits around their workforce – from preventative care to tailored clinical pathways.

For example, some businesses build in mental health support, physiotherapy, and digital GP access, helping employees get faster care and reducing time off work. Others go further, tailoring their trusts to the needs of their workforce – from musculoskeletal treatment in physically demanding industries to services that support long-term health. In fact, our data shows that the use of chronic condition services rose 92% year on year in H1 2025, showing how trusts are being used to keep people healthier for longer.

We’re also seeing growth in areas that traditional PMI often overlook. In H1 2025, gender-specific healthcare benefits rose 27% year on year and reproductive health 15%. This reflects growing demand for support with issues like menopause and fertility, and shows how trusts give employers the flexibility to offer benefits that feel more relevant and inclusive to today’s workforce.

When benefits reflect what employees really need, engagement rises, absence falls, and businesses see returns not just in lower claims costs but in a stronger, more resilient workforce.

What other organisations can learn

If over half (52%) of larger employers who don’t yet have a healthcare trust are considering making the move, the obvious question is: why not others? Trusts have historically been seen as complex and only for big corporates, but they’re now accessible to a wider range of employers.

With the right partner they’re simple to set up, easy to administer, and can even be outsourced while employers keep full oversight. Concerns about runaway costs are also outdated – stop-loss insurance ensures budgets are protected.

For mid-sized firms, the appeal is growing fast. They’re large enough to predict claims with confidence, yet small enough that every pound saved on IPT or insurer margin really counts. By adopting the same principles that have worked for larger corporates, smaller organisations can build healthcare strategies that rival the best in the market.

Healthcare trusts have become the smart and flexible option for investing in people. They offer cost savings, transparency, and benefits designed around employee needs. For both the UK’s largest employers and the growing number of mid-sized firms making the switch, trusts provide a route to healthier staff and stronger, more resilient businesses.